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    1) Dr. Robert Booth is the Chief of Orthopedic Surgery at Rittenhouse Medical Center (RMC) and leads two groups - one with 10 surgeons and the other with 7 surgeons including himself. 2) Dr. Booth's practice, 3B Ortho, is highly profitable and standardized, performing high volumes of knee surgeries in 30 minutes each through standardized practices. 3) Payment for surgeries comes from Medicare, Medicaid, and private insurers who set fixed rates per procedure that do not reflect actual costs of performing surgeries.

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    1) Dr. Robert Booth is the Chief of Orthopedic Surgery at Rittenhouse Medical Center (RMC) and leads two groups - one with 10 surgeons and the other with 7 surgeons including himself. 2) Dr. Booth's practice, 3B Ortho, is highly profitable and standardized, performing high volumes of knee surgeries in 30 minutes each through standardized practices. 3) Payment for surgeries comes from Medicare, Medicaid, and private insurers who set fixed rates per procedure that do not reflect actual costs of performing surgeries.

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    23 views1 page

    Assaj Style

    Uploaded by

    Anagh
    1) Dr. Robert Booth is the Chief of Orthopedic Surgery at Rittenhouse Medical Center (RMC) and leads two groups - one with 10 surgeons and the other with 7 surgeons including himself. 2) Dr. Booth's practice, 3B Ortho, is highly profitable and standardized, performing high volumes of knee surgeries in 30 minutes each through standardized practices. 3) Payment for surgeries comes from Medicare, Medicaid, and private insurers who set fixed rates per procedure that do not reflect actual costs of performing surgeries.

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    of 1

    Neela Wilson COO - Rittenhouse Medical Center ( RMC) RMC è Orthopedic Servicè Group 1 - Surgeon ** 10 Surgeons

    Dr Robert BoothChief Of Orthopedic Surgery è FACULTY Practice


    This would slightly increase the LABOR COST ( Slightly ) - Faculty in the RMC ( A primary Teaching Institution )
    This would initiate a sense of disparity between staff - Teaching + Research + Patient Care
    Dr Robert Boothè Nurses & techniciè Significant Merit based pay increase - Received Salaries based on seniority & not on number
    Reson è Staff Was integrat To The Efficiency and Quality Of The Care of patients provided with care
    They worked as a highly integrated teams
    ** 7 Surgeons è Group 2 - 3B Ortho ( Booth + Bartolozzi+Balderstom )
    è Knee Surgery Is Highly Specialised and require standardised practices - No Formal Teaching Responsibility
    Other surgoen took 1-2 hrs - Treated High Volume Of Patients
    Dr Booth Took 30 min - This Practice of 3B Ortho was also highly profitable
    His way was VOLUME and STANDARDISATION OF THE PRACTICES è Rented office Space in RMC building
    è Surgeons Sub Specialised into one speciality
    è Accounted for 22% RMC revenue
    è
    è

    RMC è Net Revenue


    è $ 335 M
    350 Beds Orthopedic Surgery è Knee Surgery è 95%
    20000 Inpatient Addmission Anually è Hip Surgery è 5%
    5 Operating rooms
    è Hospital Provided
    è Diagnostics and Theraputic Services 1970 è 2006
    è Service Include - Obstetrics + Orthopedics + Surgical Specialities Start 2500
    è Teaching & Research Joint Repl per yr
    è Training New Physicians and Other Medical Professionals
    è RMC Offered Residency Program To Train New Physicians
    As of 2006 - RMC - Leader iN terms of Education Research and patient Care
    Issue in 1990s è Hospitals Had Financial Pressures due to declining reimbursements è To respond Hospital Did - M&A and Affiliations - To Create a larger Health Care system
    from managed care organisations and Insurers Thereby - Economics in scale of both scope and health care

    Payment è Insurer 1 è MEDICARE INSURER MEDICARE INSURER


    >65 yrs Largest Payer For Orth Sur in RMC è 500 Diagnosis Related Group
    è Insurer 2 è MEDICAID INSURER Flat Fee Per Patient Addmission For Each Group
    è Insurer 3 è Private Insurance Companies Private Insurance Followed the Same
    è Direct è Direct Payment By Patients Issue 1 HOSPITAL HAD NO ABILITY TO SET ITS OWN PRICES
    è FOC è Free Care è Provided by Hospital RMC at their Expense Issue 2 THESE RATE DID NOT REFLECT THE ACTUAL COST TO PERFORM

    Rev 3B(22%) Grp1(78%)


    2002 275422 60593 214829.2 3B(22%) Grp1(78%)
    2003 279692 61532 218159.8 Operating Room Common Common
    2004 306159 67355 238804 Operating Staff Common Common è Physician Assistant è Hospital Employe è Hourly Rate
    2005 322348 70917 251431.4 RMC Central Deptt Common Common Nurses è Hospital Employe è Hourly Rate
    2006 337544 74260 263284.3 Anethetic Technicians è Hospital Employe è Hourly Rate
    â
    Private Practicioners è Saperately Billed for services

    1st è Pre admission tests


    è info of surgery Issue 1 Instrument sets specific for particular type of implant and implant manufascturer
    è post surgical rehabilitation Issue 2 Last minutes changes in the surgery schedule & delivery of specific sets
    è placement of order for central supply deptt along with lead time of sterlization
    è Sterlising & delivering the instrument sets for the procedure è
    è knee surgery - require - diverse set of reusable instruments
    è post procedure - re sterlise the instruments
    è **** Any sterlisation required 3 hrs
    45 min - washing
    60 min = heat sterlising
    75 min = cooling
    2nd On Day of procedue
    è Addmission
    escorted to pre operative area
    nurse/anesthetic getting briefs

    3B ortho model
    è End to end patient care
    è Efficiency is the goal è 100% time the focus to be on surgery
    è Lower surgical time è Surgical time increase per hr $1200 - $1500 New tool should be handed over precisely by the staff
    è Stadardise the practice è Avoid Innovation & Changes â
    è Standardise the parts This required substaintial commitment by the resource
    è Simplify instrumentations è 100 % focus over only knee replacement
    è Perform each step singly and completely â
    è Cpnsolidate supplies
    Pre-reqiuistire â
    è Dedicated Operating room Nurses Thereby consolidated SUPPLIERS TOO
    è Dedicated Anesthetic team â
    è Having patients in a single saperate area - A single anesthetic cam manage many patients Zimmer supplier - RMC

    recommendation of surgery is based on


    Issue 1 Saperate admitting area for 3B ortho surgery
    â
    Reason - bottle neck process is addmission office paper works

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